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Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Presentation of Case. Dr. Steven Jay Isakoff (Hematology–Oncology): A 32-year-old woman was seen in the outpatient cancer center at this hospital because of infiltrating ductal carcinoma of the right breast. The patient had been well until 2 months before admission, when she became aware of a…
- May 24, 2012
- Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
- N Engl J Med 2012; 366:2018-2026
- CME
A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.
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Images in Clinical Medicine
Aquagenic Wrinkling of Palms in Cystic Fibrosis
Figure 1.
- May 24, 2012
- Weibel L. and Spinas R.
- N Engl J Med 2012; 366:e32
- Free Full Text
A 17-year-old girl presented with a 10-year history of transient excessive wrinkling of her palms after brief exposure to water and sweating. She reported some uncomfortable tightness of the skin during these epi¬sodes.
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Images in Clinical Medicine
Meconium-like Ileus in Cystic Fibrosis
Figure 1.
- May 24, 2012
- Lin L.-Y. and Wong J.-U.
- N Engl J Med 2012; 366:2017
- Free Full Text
A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed a typical mechanical obstruction.
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Case Records of the Massachusetts General Hospital
Case 15-2012 — A 48-Year-Old Woman with Diplopia, Headaches, and Papilledema
Presentation of Case. Dr. Rocío Hurtado (Infectious Diseases): A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. The patient had been well until 2 weeks before admission, when diplopia developed, which improved when she covered either eye. One week…
- May 17, 2012
- Venna N., Coyle C.M., González R.G., Hedley-Whyte E.T.
- N Engl J Med 2012; 366:1924-1934
A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. Imaging revealed cysts in the fourth ventricle and spinal canal. A diagnostic procedure was performed.
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Images in Clinical Medicine
Nevus Sebaceous
Figure 1.
- May 17, 2012
- Cifuentes L. and Ziai M.
- N Engl J Med 2012; 366:1923
- Free Full Text
A 6-year-old girl who was born with a plaque on her forehead presented to the clinic. The plaque was smooth, elevated, and arranged in a linear pattern on the forehead.
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Images in Clinical Medicine
“Half-Half” Blisters
Figure 1.
- May 17, 2012
- O'Connell M. and Goulden V.
- N Engl J Med 2012; 366:e31
- Free Full Text
A 66-year-old man presented with an acute pustular eruption. On examination, an annular rash with multiple blisters was seen on the patient's trunk; the blisters contained both clear and yellow fluid. He had no associated cutaneous or systemic symptoms, ...
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Images in Clinical Medicine
Vertebra Plana with Spontaneous Healing
Figure 1.
- May 10, 2012
- Tsai P.-Y. and Tzeng W.-S.
- N Engl J Med 2012; 366:e30
- Free Full Text
A 3-year-old girl presented with a 3-week history of low back pain. Physical examination revealed mild tenderness over the upper lumbar spine.
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Case Records of the Massachusetts General Hospital
Case 14-2012 — A 43-Year-Old Woman with Fever and a Generalized Rash
Presentation of Case. Dr. Sarah Gee (Dermatology): A 43-year-old woman was admitted to the hospital because of fever and a generalized rash. The patient had a history of atopic dermatitis and had been in her usual health until approximately 1 week before admission, when a painful, pruritic rash…
- May 10, 2012
- Mackool B.T., Goverman J., Nazarian R.M.
- N Engl J Med 2012; 366:1825-1834
- CME
A 43-year-old woman with a history of atopic dermatitis was admitted to the hospital because of fever and a generalized painful, pruritic rash involving the entire body. Examination revealed vesicles, pustules, and erosions with scalloped borders. A diagnostic test result was received.
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Images in Clinical Medicine
An Electrocardiographic Sine Wave in Hyperkalemia
Figure 1.
- May 10, 2012
- Petrov D.B.
- N Engl J Med 2012; 366:1824
- Free Full Text
A 62-year-old man with chronic renal insufficiency reported having reduced exercise tolerance for the previous week. The physical examination was unremarkable, but oxygen saturation was diminished.
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Images in Clinical Medicine
Lymphangioma Circumscriptum
Figure 1.
- May 3, 2012
- Tan S.-K. and Tay Y.-K.
- N Engl J Med 2012; 366:1724
- Free Full Text
A 52-year-old man presented with a 1-year history of a vesicular rash on his scrotum. The lesions were painless, but they occasionally ruptured and drained clear fluid.
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Images in Clinical Medicine
Eschar Formation from Testosterone Patch
Figure 1.
- May 3, 2012
- Orme C. and Imaeda S.
- N Engl J Med 2012; 366:e28
- Free Full Text
A 78-year-old man presented for his yearly skin exam and was noted to have an oval-shaped, green-black eschar on his midback. A pink, atrophic scar was located nearby, in addition to a medicated patch of similar size.
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Clinical Problem-Solving
Whistling in the Dark
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 38-year-old woman living in…
- May 3, 2012
- Solomon D.A., Fanta C.H., Levy B.D., Loscalzo J.
- N Engl J Med 2012; 366:1725-1730
- CME
Shortness of breath, fever, and cough productive of yellow sputum developed in a 38-year-old woman soon after the birth of her third child. Although her symptoms initially resolved with antibiotics, an intermittent nonproductive cough, wheezing, and shortness of breath soon followed.
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Images in Clinical Medicine
Torsion of Undescended Testis
Figure 1.
- April 26, 2012
- Hajji F. and Janane A.
- N Engl J Med 2012; 366:1625
- Free Full Text
A 22-year-old man with a history of uncorrected left cryptorchidism presented after 7 days of left groin pain. A genitourinary examination was performed, which revealed that his left inguinal region was swollen because of a palpable, tender mass.
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Images in Clinical Medicine
Pneumoperitoneum
Figure 1.
- April 26, 2012
- Ailon J.
- N Engl J Med 2012; 366:e26
- Free Full Text
A 69-year-old woman presented to the emergency department with a 3-day history of progressively worsening abdominal distention and pain. She was taking dexamethasone for cerebral edema associated with glioblastoma multiforme.
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Case Records of the Massachusetts General Hospital
Case 13-2012 — A 62-Year-Old Man with Paresthesias, Weight Loss, Jaundice, and Anemia
Presentation of Case. Dr. Norifumi Kamo (Medicine): A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. The patient had been well until approximately 2 months before admission, when numbness, tingling ("pins and needles"), and burning in his…
- April 26, 2012
- Puig A., Mino-Kenudson M., Dighe A.S.
- N Engl J Med 2012; 366:1626-1633
- CME
A 62-year-old man was admitted to this hospital because of paresthesias, weight loss, jaundice, and anemia. Diagnostic test results were received.
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Case Records of the Massachusetts General Hospital
Case 12-2012 — A 10-Month-Old Girl with Vomiting and Episodes of Unresponsiveness
Presentation of Case. Dr. Helen H. Yeung (Pediatrics): A 10-month-old girl was seen in the emergency department at this hospital because of vomiting and episodes of unresponsiveness. The patient had been well until 2 a.m. on the day of admission, when she awoke with vomiting that was associated…
- April 19, 2012
- Sassower K.C., Allister L.M., Westra S.J.
- N Engl J Med 2012; 366:1527-1536
- CME
A 10-month-old girl was seen in the emergency department because of vomiting and episodes of unresponsiveness, which had begun suddenly 7 hours earlier. She gradually became somnolent. Vital signs, a physical examination, and brain imaging were normal.
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Images in Clinical Medicine
Metastatic Inguinal Lymphadenopathy
Figure 1.
- April 19, 2012
- Hajdarbegovic E. and Balak D.
- N Engl J Med 2012; 366:1526
- Free Full Text
A 59-year-old man presented with a weeping mole on his back that had been growing for 8 years. On examination, a 10-cm ulcerated lesion was found on his lower back, and multiple subcutaneous areas of swelling were found in both inguinal regions.
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Images in Clinical Medicine
Unilateral Dermatoheliosis
Figure 1.
- April 19, 2012
- Gordon J.R.S. and Brieva J.C.
- N Engl J Med 2012; 366:e25
- Free Full Text
A 69-year-old man presented with a history of gradual thickening and wrinkling of the skin on the left side of his face. The physical examination showed hyperkeratosis with accentuated ridging, multiple open comedones, and areas of nodular elastosis.
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Interactive Medical Case
Whistling in the Dark
A 38-year-old woman in Florida presented to her primary care physician with shortness of breath, fever, and a cough productive of yellow sputum. She was treated empirically with antibiotics for a presumed respiratory tract infection, and her symptoms resolved. She returned a few weeks later with an…
- April 12, 2012
- Vaidya A., Solomon D.A., Fanta C.H.
- N Engl J Med 2012; 366:e24
- Free Full Text
- CME
A 38-year-old woman had shortness of breath, fever, and cough with yellow sputum soon after childbirth. Her symptoms initially resolved with antibiotics, but she soon had nonproductive cough, wheeze, and shortness of breath. Test your diagnostic and therapeutic skills at NEJM.org.
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Images in Clinical Medicine
Achalasia
Figure 1.
- April 12, 2012
- Jafferbhoy S. and Rustum Q.
- N Engl J Med 2012; 366:e23
- Free Full Text
A 43-year-old woman presented to the surgical clinic with an 8-month history of weight loss and progressive dysphagia to solids and liquids. She also had dyspepsia and depression.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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